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BACKGROUND Initial management of severe traumatic brain injury is important and includes treatment decision-making and prediction of prognosis. We examined whether biomarkers at admission could be useful prognostic predictors. We focused on electrolytes and blood glucose, which can be measured easily at any facility and for which results can be obtained promptly, before those of other biomarkers, such as D-dimer. METHODS All trauma patients with head injuries treated at Chiba Hokusoh Hospital between 2014 and 2017 were investigated. Cases of multiple trauma accompanied by fatal trauma, hemorrhagic shock, or cardiopulmonary arrest, and pediatric cases, were excluded from this study. Blood gas data at the initial hospital visit were reviewed retrospectively. A poor outcome was defined as death during hospitalization or a vegetative state due to head injury. Factors related to poor outcomes were analyzed. RESULTS Of the 185 male and 79 female patients studied, 34 had poor outcomes. Poor outcome was significantly correlated with potassium (P = 0.003), glucose (P < 0.001), and glucose-to-potassium ratio (P < 0.001) at arrival. The odds ratio was 4.079 for a glucose-to-potassium ratio of ≥50. CONCLUSIONS We evaluated blood gas data at the initial hospital visit, as these results can be obtained more quickly than those of other biomarkers assessed previously. Serum glucose-to-potassium ratio at admission may be a potential predictor of prognosis for severe traumatic brain injury.

Pyruvate markedly enhanced lipolysis induced by triiodo- l -thyronine (L-T3) or methylxanthines in fat cells from fasted rats, but not from fed rats. In contrast, pyruvate only slightly increased lipolysis which had been submaximally elevated by epinephrine, adrenocorticotropic hormone or thyroid-stimulating hormone, and did not affect the lipolytic effect of lutenizing hormone, growth hormone plus dexamethasone or hydrocortisone. Insulin and prostaglandin E1 blocked this pyruvate effect on T3-induced lipolysis. In the presence of 5 mM pyruvate, a significant lipolysis was observed with 0.001 mM L-T3; a near maximal effect was seen with L-T3 at 0.1 mM. Conversely, lipolysis induced by 0.1 mM L-T3 was clearly augmented with 0.01 mM pyruvate; a maximal effect was seen with pyruvate at 5mM. Pyruvate itself had no effect on basal lipolysis, but promptly stimulated T3-induced lipolysis after its addition. Furthermore, pyruvate (0.01 to 5 mM) did not alter the ratios of fatty acid/glycerol released during lipolysis induced by 0.1 mM L-T3. Pyruvate also markedly augmented T3-induced formation of cAMP in fat cells from fasted rats. This accumulation of cAMP was blocked by AMP, a potent inhibitor of lipolysis induced by T3 plus pyruvate.

SUMMARY 1). The anti-manic, anti-depressive and prophylactic effects of carbamazepine (CAZP, Tegretol-Ciba Geigy) on the endogenous mani-depressive psychosis (MDP) were investigated on 50 MDP cases. The dosage of the drug ranged from 200 to 1,200 mg daily (usually 400 to 600 mg). 2). The effect of CAZP on 33 manic states was: “markedly effective” seven (23%), “effective” six (19%), “slightly effective” five (16%), “ineffective” 13 (42%), whereas the effect on six depressive states was: “markedly effective” one and “ineffective” five. No definite relationship was found between the kinds of drugs in combination use and the effect of CAZP. No significant difference of the CAZP effect was found in the four patient groups with different age of onset of the illness, nor among the “continuous,”“frequent” and “periodic” type cases. 3). The prophylactic effect of CAZP on 27 cases in which the assessment of the effect on the manic episode was possible was: “markedly effective” 13 (48%), “effective” seven (26%) and “ineffective” seven (26%), whereas that for depressive episode was: 12 (45%), two (7%) and 13 (48%), and the result of the general assessment on each patient was 14 (43%), 10 (30%) and nine (27%), respectively. The kinds of drugs in combination use, age of onset and type of course of the illness did not have any influence on the prophylactic effect of CAZP. 4). The prophylactic effect on MDP of CAZP did not parallel that of lithium salt, but CAZP may be effective on cases which did not respond to lithium and vice versa. 5). Side-effects such as ataxia, dizziness, exanthema, drowsiness and headache were observed in five of the cases, and the CAZP was discontinued in four of them. 6). The mechanism of effectiveness of the CAZP on MDP was discussed.